Charlie Kornberg's Musculoskeletal Physiotherapy Home Page

Compartment Syndromes

Many terms used to describe compartment syndromes:

Tibial syndrome; shin splints; exercise ischaemia and myositis (inflammation of muscle). It is currently known as “exertional compartment syndrome”.

A compartment, in this context, is a part of the leg that is bounded by bone, ligament, fascia (thick flat tissue) in which the muscle or muscle sits e.g. anterior compartment where the tibialis anterior muscle is bounded by the tibia (shin bone) and the fibula and deep fascia – ask everyone to have a feel.

Broadly defined as a condition in which increased pressure within a muscle compartment, brought about by increased effort or exercise, impedes the blood flow to that compartment.

Symptoms arise because the increased pressure causes ischaemia (decreased blood flow) of the tissues contained within the compartment, particularly the muscles and nerves. Muscle ischaemia causes pain and nerve ischaemia causes weakness and sensory symptoms in the distribution of the nerve. Although not related, the example of nerve ischaemia is when you get pins and needles when you sit cross legged too long.

Two types of compartment syndromes exist – the acute compartment syndrome – usually brought on by trauma or usually in someone who is unaccustomed to strenuous activity – there is an acute onset of symptoms after the exercise, with severe pain, swelling and paralysis – this is a surgical emergency as the nerve and blood vessels have to be decompressed. The second is the chronic compartment syndrome – these are usually characterised by there being symptom free between episodes i.e. symptoms are gone between exercise bouts.

The most common compartment syndromes occur in the lower leg, in particular the anterior or deep posterior compartment, but can also happen in the peroneal compartment – the outside part of the shin.

The pathological pathway is as follows:

Common Symptoms

Pain, muscle tightness or swelling, a cramp like feeling, weakness or numbness during exercise. It usually occurs during weight bearing exercise e.g. walking, running, jumping. The patient will often complain it happens at about the same time or intensity of exercise e.g. 15 minutes into a run, a certain number of reps on the track.

The pain will often stop the patient from exercise, but as the problem becomes more chronic, it will take longer for the symptoms to abate.

How do we find out whether you have a compartment syndrome?

Since increased muscle volume occurs with increased exercise, there is an increase in compartmental pressure. This pressure can be measured with a “wick” or “slit” catheter, which is inserted into the compartment under local anaesthetic. Normal resting pressure in a compartment is between 0-15 mmHg. With exercise, this pressure may rise to 30-40 mmHg but will return to normal limits within a few minutes.

In chronic compartment syndromes, the resting pressure may be in the normal range or slightly higher, but can rise to as much as 80 mmHg with exercise, and stay elevated for 15 – 30 minutes.

Treatment of compartment syndrome

Acute – surgical emergency.

Chronic – conservative treatment may be of some benefit e.g. physiotherapy: deep massage of the compartments, ultrasound, interferential therapy, magnetic field therapy, a lot of stretching and ice. If it is not successful after 6 weeks, cessation of that particular sport or surgery should be considered.

Surgery – known as fasciotomy – which is the splitting of the deep tissues to allow more room for the muscles to expand. Pressure measurements are taken before and after surgery to determine success of the decompression. Post operatively, the patient gets range of motion exercises, weight bears as comfortable (usually with crutches the first few days and then weight-bearing fully ASAP. The biggest problems faced after this type of surgery are: wound breakdown and infection and haematoma formation – this can create scar tissue around the fasciotomy and lead to a closing of the released area and hence a recurrence.

The concepts presented here are entirely the author's own (unless expressly stated) and do not represent the thoughts or ideas of any other person.

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